THE CONSENSUS SLEEP DIARY

http://dx.doi.org/10.5665/sleep.1642

The Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring

Colleen E. Carney, PhD1; Daniel J. Buysse, MD2; Sonia Ancoli-Israel, PhD3; Jack D. Edinger, PhD4; Andrew D. Krystal, MD5; Kenneth L. Lichstein, PhD6;
Charles M. Morin, PhD7
1
Ryerson University, Toronto, Canada; 2University of Pittsburgh School of Medicine, Pittsburgh, PA; 3University of California San Diego, La Jolla, CA;
4
Veterans’ Affairs and Duke University Medical Centers, Durham, NC; 5Duke University Medical Center, Durham, NC; 6The University of Alabama,
Tuscaloosa, AL; 7Laval University, Quebec, Canada

Study Objectives: To present an expert consensus, standardized, patient-informed sleep diary.

Methods and Results: Sleep diaries from the original expert panel of 25 attendees of the Pittsburgh Assessment Conference1 were collected
and reviewed. A smaller subset of experts formed a committee and reviewed the compiled diaries. Items deemed essential were included in a
Core sleep diary, and those deemed optional were retained for an expanded diary. Secondly, optional items would be available in other versions. A
draft of the Core and optional versions along with a feedback questionnaire were sent to members of the Pittsburgh Assessment Conference. The
feedback from the group was integrated and the diary drafts were subjected to 6 focus groups composed of good sleepers, people with insomnia,
and people with sleep apnea. The data were summarized into themes and changes to the drafts were made in response to the focus groups. The
resultant draft was evaluated by another focus group and subjected to lexile analyses. The lexile analyses suggested that the Core diary instruc-
tions are at a sixth-grade reading level and the Core diary was written at a third-grade reading level.
Conclusions: The Consensus Sleep Diary was the result of collaborations with insomnia experts and potential users. The adoption of a standard
sleep diary for insomnia will facilitate comparisons across studies and advance the field. The proposed diary is intended as a living document which
still needs to be tested, refined, and validated.
Keywords: Sleep diary, insomnia, sleep assessment
Citation: Carney CE; Buysse DJ; Ancoli-Israel S; Edinger JD; Krystal AD; Lichstein KL; Morin CM. The consensus sleep diary: standardizing pro-
spective sleep self-monitoring. SLEEP 2012;35(2):287-302.

INTRODUCTION estimate treatment effect sizes.5-8 However, these effect size

Insomnia is a very prevalent and significant sleep disorder
associated with reduced quality of life, increased healthcare
costs, and increased risks for serious psychiatric and medical
comorbidities.2,3 Over the past four decades, a bourgeoning
body of research has focused on the epidemiology, causes, con-
sequences, and treatment of this condition. This research has
advanced our understanding of the manifestations and manage-
ment of insomnia. Yet, as noted in a previous consensus report,1
the collective impact of these studies has been limited by a lack
of standardization in insomnia research methodologies. This
lack of standardization, in turn, has contributed to inconsisten-
cies in study findings that have hindered our ability to translate
research findings into clinical practice.
This lack of standardization spilled over to some of the
most basic tools used in insomnia research, such as the sleep
diary. While there is widespread agreement that a sleep di-
ary should routinely be included in insomnia research,1 the
absence of a standardized and widely used sleep diary has
compromised the ability to fully interpret and integrate results
of previous studies.4 For example, meta-analyses of insomnia
treatment studies have primarily relied on sleep diary data to
A commentary on this article appears in this issue on page 175.
Submitted for publication March, 2011
Submitted in final revised form June, 2011
Accepted for publication June, 2011
Address correspondence to: Colleen E. Carney, PhD, Ryerson Univer-
sity, 350 Victoria Street, JOR807, Toronto, Ontario, Canada M5B 2K3;
Tel: (416) 979-5000 ext. 2177; Fax: (416) 979-5273; E-mail: ccarney@
ryerson.ca
SLEEP, Vol. 35, No. 2, 2012
estimates were based on data from a variety of sleep diaries
with distinctive instructional sets and inconsistent definitions
of target sleep measures.
Researchers agree that having insomnia sufferers prospec-
tively self-monitor or record their sleep on a night-by-night
basis with a sleep diary is a useful methodology for assess-
ment and for tracking treatment effects.1,9,10 Moreover, there is
agreement that such self-monitoring should yield information
about a number of relevant metrics including nightly sleep
onset latency (SOL), wakefulness after initial sleep onset
(WASO), total sleep time (TST), total time spent in bed (TIB),
sleep efficiency (SE, i.e., the percent of the time asleep out
of amount of time spent in bed), and sleep quality or satis-
faction, which reflects a subjective global appraisal of each
night’s sleep. On the other hand, researchers have not agreed
on the format of the sleep diary. In fact, multiple lab-specific
sleep diaries have emerged, with response formats including
numerical sleep/wake estimates, Likert ratings, and visual
analogue scales. Diaries also vary as to whether respondents
were asked to provide estimates of all of the key parameters
or whether some parameters, such as TST and WASO, were
calculated from other parameters. Finally, researchers have
used various definitions and different calculations for indices
such as SE and WASO (including or not including the final
awakening), the primary measures of interest in many insom-
nia clinical trials.
Despite the lack of a standardized format, the sleep diary has
been regarded as the “gold standard” for subjective sleep as-
sessment. Clearly the adoption of a standard sleep diary would
be a major step toward moving the field forward. Based on
these considerations, the development of a standardized, con-
sensually supported sleep diary is long past due.1
287 Consensus Sleep Diary—Carney et al
 The development of such a diary, however, faces a number of
challenges. The considerable diversity among the sleep diaries
used in previous research suggests that there are many differ-
ent points of view about: (1) the range of questions that should
be included and how these questions should be worded; (2)
how the diary should be formatted; (3) whether the sleep di-
ary should elicit quantitative responses, qualitative responses,
or both; (4) how common sleep parameters (SOL, WASO, SE)
should be defined; (5) how much data should be acquired on a
single sleep diary form (one day, one week, two weeks, etc.);
and (6) what time of day respondents should complete diary
questions (i.e., in the morning, in the evening or both). Reach-
ing consensus among insomnia researchers would be an impor-
tant first step.
Qualitative research on the acceptability of the diary by pa-
tients and research subjects would also be important to deter-
mine and has not been carried out for existing diary versions
(for example, whether they understand the diary questions as
intended and if they able to complete the diary easily over
extended self-monitoring periods without incurring undue
burden). Indeed, the U.S. Food and Drug Administration has
suggested that soliciting patient-reported outcomes (PROs) is
an important piece in the development and validation of mea-
sures to be used in labeling studies.11 Thus, a consensus-based
standardized sleep diary that is also informed by patient/user
opinion could greatly advance the field.
Recognizing the challenges these considerations pose, a
workgroup was formed to develop and propose a consensus-
based standardized sleep diary. The specific aims of this work-
group were to: (1) review the range and nature of sleep diaries
previously used in insomnia research; (2) solicit diaries cur-
rently used from a large group of insomnia researchers; (3)
identify commonalities in previously used sleep diaries and
integrate those commonalities into a consensus instrument; (4)
solicit critical input about the resultant consensus sleep diary
from a wide range of insomnia researchers; (5) conduct qualita-
tive field testing with patients to acquire additional information
to be used for refining the diary instrument and its associated
instructional set; and (6) conduct preliminary lexical analyses
on the reading level required for the measure.
METHODS
The consensus sleep diary project was an outgrowth of the
2005 Insomnia Assessment Conference which resulted in a
publication with recommendations for standard research as-
sessment of insomnia.1 The original conference was convened
in Pittsburgh, PA, and was comprised of an Organizing Com-
mittee (consisting of Daniel J. Buysse, Sonia Ancoli-Israel,
Jack D. Edinger, Kenneth L. Lichstein, and Charles M. Mo-
rin) and 20 invited insomnia experts selected for their research
contributions to the field of insomnia as well as for their broad
representation of different types of insomnia research.
Beginning in 2008, the five members of the organizing com-
mittee and two additional insomnia researchers (Colleen E.
Carney and Andrew D. Krystal) participated in a workgroup
convened to develop a consensus sleep diary. This workgroup
held a number of conference calls for planning purposes and
then convened for a face-to face meeting in Chicago, IL, on
April 28-29, 2008 to discuss general objectives and strategies
SLEEP, Vol. 35, No. 2, 2012
for developing a consensus sleep diary. The group agreed on
the following decisions concerning the general purpose and for-
mat of the diary to be developed. Additionally, the group agreed
upon the method whereby items would be evaluated:
• The Consensus Sleep Diary (CSD) would be developed
primarily for the purposes of insomnia research. Howev-
er, the structure of the CSD would also be general enough
to be useful for clinical and research applications for all
sleep disorders as well as for good sleepers.
• The CSD would build upon sleep diaries previously used
in insomnia research to facilitate comparisons across past
and future studies.
• Recommendations regarding the CSD from the larger
group of insomnia experts who attended the 2005 Pitts-
burgh Assessment Conference1 would also be captured.
For example, there would be consistency in the calcula-
tion of sleep indices described in Buysse et al.1 and in the
new CSD (see Table 1).
• Alternate forms of the CSD would be developed to of-
fer researchers optimal flexibility in addressing research
questions. A “Core” CSD would be developed that includ-
ed a standard set of items minimally sufficient for sleep
diary-based research while an expanded form would al-
low applications that require tracking daytime data (e.g.,
napping, caffeine use, daytime alertness).
• Previously developed diaries would be solicited from the
insomnia research community, including Pittsburgh As-
sessment Conference members, and these diaries would
be analyzed, compared, and discussed among the CSD
Workgroup members to identify those items most com-
monly used and likely to be supported by the insomnia
research community.
• The Core CSD would be designed to fit on a single
8.5” × 11” page in landscape format, whereas the expand-
ed CSD version would be designed to fit on the front and
back sides of a single page. This was primarily a practical
solution that was made in order to both save paper and to
appear less daunting to a diary user.
• The wording of the diary items would be in past tense
since they are most often completed the morning after the
night being reporting upon.
• All questions would be written in the second person so
that it would appear as though the researcher/clinician
was inquiring about the sleep behaviors.
The workgroup then solicited copies of sleep diaries from
all 25 members of the original Pittsburgh Assessment Confer-
ence. Items from the submitted diaries were grouped according
to item content and placed together on a worksheet for review.
For example, items that assessed respondents’ estimates of how
long it took to initially fall asleep were grouped together. The
worksheet had no indication of the original sources.
Once all sets of items were placed on the worksheet, each
member of the workgroup rated their top three choices for each
item’s wording. Members were also permitted to suggest new
wording if no choices were desirable. For example, if an item set
contained no options worded in the past tense or second person,
new items were constructed. The results of the item rating and
the rewording process were circulated among members, who
were blind to the identity of the person suggesting the reworded
288 Consensus Sleep Diary—Carney et al
items. The workgroup then reviewed the results of the item rat-
ings and rewording via teleconference and agreed upon the final
wording of each item. In many cases there was a high degree of
agreement. For cases in which the group was divided about the
optimal item wording, consensus was achieved through discus-
sion. The workgroup also discussed whether each item would
be included as part of the Core CSD or remain as an optional
item on the expanded CSD. The results of this teleconference
yielded an initial draft of the core and expanded CSD items.
The items were then entered into a self-report tabular for-
mat which was discussed on a subsequent teleconference. The
workgroup agreed to include guidelines for respondents within
the diary itself to decrease the likelihood of common mistakes.
For instance, the workgroup agreed it was important to include
indicators for whether a time was AM or PM, denoting whether
the number refers to minutes or hours, and including tick boxes
next to qualitative Likert scale items. A sample column was in-
cluded to model the desired format of responses. Once the for-
mat was agreed upon, instructions for the diary were written. In
formulating these instructions, workgroup members discussed
their clinical observations of common pitfalls in completing
diaries. For example, some patients/respondents have difficulty
ascertaining if diary questions pertain to the previous or en-
suing night. It was agreed that the instructions needed to be
explicit and written at or below an eighth-grade reading level.
The first author (CEC) then drafted a set of instructions for the
diaries and circulated them for the other members to discuss in
a subsequent teleconference on which the instructions were fur-
ther revised to ensure they were sufficiently clear. The reading
level tool in Microsoft Office 2007 Word was used to determine
the reading level.
Draft versions of the core and expanded (i.e., optional items)
CSD along with their instructional sets were then circulated to
the 2005 Pittsburgh Assessment Conference members for feed-
back. In addition to the CSD and instructions, a questionnaire
was also included. The diaries and instructions were re-edited
based on the responses. The workgroup then conducted qualita-
tive research with potential respondents’ focus groups.
Focus Groups: Rationale and Procedures
Previous research on focus groups suggested that obtaining
participant input via methods such as focus groups is a crucial
component of developing patient reported outcomes (PRO).11,12
Focus groups were therefore conducted to evaluate the core and
expanded CSD to ensure that the PRO items actually measured
the constructs and phenomena relevant to the insomnia patient
or subject.
In general, focus groups consist of small groups of people
who are asked in general terms about their perceptions, opin-
ions, beliefs, and attitudes towards methods for evaluating
the construct in question. Specifically, focus group discus-
sions help the research team discover the vocabulary and
the thinking patterns of the target group in a format that en-
courages free communication. Although the results of focus
groups can be described in quantitative terms, they are best
viewed as hypothesis-generating rather than hypothesis-test-
ing procedures.15-17
The goal of the CSD focus groups was to solicit participant
opinions regarding the optimal content, wording, and format
SLEEP, Vol. 35, No. 2, 2012
(including the layout) of the CSD items. As the optional ver-
sions had the same items with differing instructions, only one
of the sleep diaries with all optional items (later referred to as
the Consensus Sleep Diary, Morning administration or CSD-M)
was used. Six focus groups were conducted: two focus groups
of good sleepers, two of individuals with insomnia, and two of
sleep apnea patients. Diagnosis was based on self-identifica-
tion. A total of 47 individuals participated (14 good sleepers,
18 with insomnia, 14 with sleep apnea; 53% female; age 18-
70 years). Participants were recruited from local sleep clinics,
research registries, and advertisements. All groups were run at
the University of Pittsburgh by master’s level facilitators with
experience in conducting focus groups for the development of
PROs in the NIH-funded PROMIS Roadmap Initiative (U01
AR52155). Following a scripted introduction explaining the
purpose of sleep diaries, each focus group was asked a set of
structured questions designed to elicit descriptions of sleep and
daytime activities and events related to sleep. In particular, they
were asked how they would describe their sleep in quantita-
tive terms (e.g., sleep timing, time to fall asleep, sleep amount,
number and duration of awakenings) and qualitative terms
(e.g., restfulness, impact of sleep on daytime function). Finally,
each group was shown the proposed sleep diary, and asked for
their comments regarding its utility, format, and adequacy for
describing their sleep.
The facilitator and a co-facilitator each took notes and devel-
oped a set of summary comments for each group. These notes
and summary comments were reviewed by the CSD workgroup
along with an external consultant with expertise in focus group
methodology (Dr. Kelly E. McShane), which resulted in a set of
major themes. A preliminary review of participants’ comments
from the first five groups led to modifications in the sample
CSD diary presented to the final group, which consisted of
sleep apnea patients.
Lexile Analysis
The core CSD as well as the expanded, optional version (later
referred to as CSD-M) of the sleep diary and the instruction sets
were both submitted to lexile analysis (http://www.lexile.com/
analyzer/), which takes into account both the semantic (word
frequency) and syntactic (sentence length) characteristics of the
writing sample resulting in a lexile score corresponding to spe-
cific reading grade levels.18,19
RESULTS
The solicitation of sleep diaries versions from the 25 mem-
bers of the original Pittsburgh Assessment Conference yielded
replies from 22 members (88% response rate). Three members
did not respond to multiple contact attempts. Of the 22 sleep
diaries that were submitted, only 16 were unique, as some ver-
sions were in use across more than one site.
There were seven replies (35%) to the request for clini-
cian feedback on the initial draft of the consensus sleep di-
ary. The first four questions of the questionnaire were Likert
scale items (rated from 0 = not at all understandable to 3
= very understandable) that asked: (1) Are the instructions
clear? (mean 3; SD = 0); (2) Are the Core items clear? (mean
3; SD = 0); (3) Is the Core diary format clear? (mean 2.8;
SD = 0.45); (4) Is the Optional diary format clear? (mean 2.6;
289 Consensus Sleep Diary—Carney et al
SD = 0.55). The next question asked: (5) Should the diary in-
clude both evening and morning sections? Of those respond-
ing, 50% reported there should be an option for completing
some items at night, 33% reported that evening completion
should not be an option, and 17% reported that this option
should be available for asking about daytime functioning
only, e.g. naps, energy, mood. The last question asked: (6)
Was there something we missed? Over half (57%) approved
of the CSD in its initial format. One respondent requested
the addition of an adherence item (e.g., whether the person
was following a treatment recommendation such as stimulus
control); however, it was decided not to include this item as
it was only relevant for treatment trials. Another suggestion
was to include direct estimate of TST as a Core rather than
optional item; however the decision was made to derive this
variable from other information in the diary, as recommended
by Buysse et al.1
Three versions of the final consensus sleep diary were cre-
ated and are shown in Figures 1-3.
The Core Consensus Sleep Diary: The CSD (Figure 1) con-
tained 9 items considered by the CSD workgroup and the 2005
conference participants to represent the most critical param-
eters. The questions ask about: (1) the time of getting into bed;
(2) the time at which the individual attempted to fall asleep; (3)
sleep onset latency; (4) number of awakenings; (5) duration of
awakenings; (6) time of final awakening; (7) final rise time; (8)
perceived sleep quality (rated via Likert scale); and (9) an ad-
ditional space for open-ended comments from the respondent.
As previously agreed upon, the core CSD was formatted so that
one week of nightly sleep data could be recorded on a single
diary page. The CSD instructions included general information,
such as what to do if the respondent misses recording on a par-
ticular day, and item-specific instructions to enhance likelihood
of correct item interpretation. For example, the instructions for
item #6 tell the respondent to record the time of the final awak-
ening in the morning. The additional instructions indicate that
all of the items are to be completed in the morning within one
hour of getting out of bed.
The Expanded Consensus Sleep Diary for Morning: An ex-
panded version of the CSD (Figure 2) included a number of
optional items that could be completed in the morning upon
arising (Optional morning completion items – CSD-M). The
CSD-M includes additional items about early (premature)
morning awakenings (EMA), estimated total sleep time, Likert
scale rating of the refreshing quality of sleep, napping/dozing,
and alcohol, caffeine, and medication use. The instructions for
the additional questions in CSD-M also stipulate that the diary
should be completed in the morning.
The Expanded Consensus Sleep Diary for Evening: A third
version of the CSD included the same items as CSD-M, but
with instructions for morning and evening completion (Option-
al morning and evening completion – CSD-E; Figure 3). The
morning and evening items in the CSD-E are grouped separate-
ly. The instructions stipulated that items about daytime activity
such as caffeine, alcohol, and medication use or napping which
appear on one side of the diary are to be completed at night be-
fore going to bed, while the remaining items which appear on
the other side and query about the previous night’s sleep are to
be completed the following morning.
SLEEP, Vol. 35, No. 2, 2012
Findings from Focus Groups
Participants’ responses to the CSD
Upon reviewing the draft version of the CSD-M, participants
offered a variety of opinions regarding alternative format and
layouts. Some participants suggested that alternate graphical
formats, such as clock faces or time charts, would be more
useful. Some advocated electronic formats, such as hand-held
or desktop computer-based. In general, participants found the
initial version to be too cluttered, the print too small, and ad-
vocated larger check boxes and less pre-printed text in the re-
sponse areas. Several participants among both good sleepers
and insomnia groups found the diary to be too complicated and
“overwhelming,” and would have preferred a single-day for-
mat. Most importantly, participants expressed it was important
to include some method for adding comments regarding impor-
tant influences on a particular night of sleep. As a result of these
comments, the sleep diary format was modified by eliminating
blank lines to fill in times, a.m./p.m. check boxes, and text with
units that followed participant responses (e.g., minutes, hours).
A “Comments” field was added for respondents to describe im-
portant qualitative and experiential aspects of sleep. The final
focus group (in sleep apnea patients) agreed that the new form
was less cluttered, but still commented that the proposed format
left little opportunity to describe specific aspects of sleep.
Participants’ description of sleep
When asked how a sleep diary could best summarize quan-
titative aspects of their sleep, participants recommended sleep
latency, sleep duration, and number and duration of awaken-
ings. However, a variety of suggestions on how best to capture
that information were given. A number of participants suggest-
ed that numerical estimates would be only crude representa-
tions of their experience. Several participants suggested that the
longest “solid” sleep period was an important quantitative as-
pect of sleep. When asked about how to document other, more
qualitative aspects of sleep, participants gave a wide variety of
responses reflecting their individual experiences. For instance,
different participants emphasized elements such as the lightness
or deepness of sleep, dream experiences, effects of physical
symptoms and medications, and the influence of environmen-
tal and emotional factors on sleep. In a similar fashion, par-
ticipants described the relationship between sleep and waking
experiences in a variety of personal ways, including effects on
cognitive, physical, and emotional well-being, as well as effects
of alertness and napping behavior. The bidirectional nature of
waking and sleep experiences was a common theme for many
participants. The most consistent overall theme was the need to
express personalized comments regarding sleep and wakeful-
ness. Participants reported that any brief quantitative summary
was inadequate to describe their sleep experience, and that it
was important to be able to describe their sleep experience in
some detail. This theme can be seen as a commentary on inter-
actions regarding sleep with health care providers in general,
beyond what a sleep diary is able to capture.
Lexile Analysis
For the CSD-Core, mean sentence length was 8.2 words (SD
2.7, range 3-12), and mean lexile Measure was 441 (SD = 185.9,
290 Consensus Sleep Diary—Carney et al
 Figure 1

Sleep Diary Instructions - Core

General Instructions

What is a Sleep Diary? A sleep diary is designed to gather information about your daily sleep pattern.

How often and when do I fill out the sleep diary? It is necessary for you to complete your sleep diary every day. If
possible, the sleep diary should be completed within one hour of getting out of bed in the morning.

What should I do if I miss a day? If you forget to fill in the diary or are unable to finish it, leave the diary blank for
that day.

What if something unusual affects my sleep or how I feel in the daytime? If your sleep or daytime functioning is
affected by some unusual event (such as an illness, or an emergency) you may make brief notes on your diary.

What do the words “bed” and “day” mean on the diary? This diary can be used for people who are awake or
asleep at unusual times. In the sleep diary, the word “day” is the time when you choose or are required to be awake.
The term “bed” means the place where you usually sleep.

Will answering these questions about my sleep keep me awake? This is not usually a problem. You should not
worry about giving exact times, and you should not watch the clock. Just give your best estimate.

Item Instructions

Use the guide below to clarify what is being asked for each item of the Sleep Diary.
Date: Write the date of the morning you are filling out the diary.
1. What time did you get into bed? Write the time that you got into bed. This may not be the time that
you began “trying” to fall asleep.
2. What time did you try to go to sleep? Record the time that you began “trying” to fall asleep.
3. How long did it take you to fall asleep? Beginning at the time you wrote in question 2, how long did
it take you to fall asleep.
4. How many times did you wake up, not counting your final awakening? How many times did you
wake up between the time you first fell asleep and your final awakening?
5. In total, how long did these awakenings last? What was the total time you were awake between the
time you first fell asleep and your final awakening. For example, if you woke 3 times for 20 minutes, 35
minutes, and 15 minutes, add them all up (20+35+15= 70 min or 1 hr and 10 min).
6. What time was your final awakening? Record the last time you woke up in the morning.
7. What time did you get out of bed for the day? What time did you get out of bed with no further
attempt at sleeping? This may be different from your final awakening time (e.g. you may have woken
up at 6:35 a.m. but did not get out of bed to start your day until 7:20 a.m.)
8. How would you rate the quality of your sleep? “Sleep Quality” is your sense of whether your sleep
was good or poor.
9. Comments If you have anything that you would like to say that is relevant to your sleep feel free to
write it here.

Figure 1—Sleep Diary Instructions: Core Figure 1 continues on the following page

range 230-880), corresponding to a third-grade reading level
(range second-seventh grade). For CSD-Core diary instructions,
mean sentence length was 13.6 words (SD 5.5, range 5-27), with
a mean lexile Measure of 755.2 (SD 334.6, range 80-1500), cor-
responding to a mean sixth-grade reading level (range less than
first grade to post-high school). The two optional versions only
differ on the format of the diary. That is, they are completed
at two different times; one version is completed entirely in the
SLEEP, Vol. 35, No. 2, 2012
morning (CSD-M), and the other version has some items com-
pleted in the morning and other items that are completed before
bed). Thus, these two versions have the same wording so only
the CSD-M was examined. For CSD-M, mean sentence length
was 9.2 words (SD 2.5, range 5-14), and mean lexile Measure
was 555 (SD 255, range 160-1040), corresponding to a third-
grade reading level (range first-eighth grade). For the CSD-M
instructions, mean sentence length was 12.3 words (SD 5.3,
291 Consensus Sleep Diary—Carney et al
 Consensus Sleep Diary—Carney et al
Consensus Sleep Diary-Core ID/Name:________________________________
Sample
Today’s date 4/5/11
1. What time did
you get into bed?
10:15 p.m.
2. What time did
you try to go to 11:30 p.m.
sleep?
3. How long did it
take you to fall 55 min.
asleep?
4. How many
times did you
wake up, not 3 times
counting your final
awakening?
5. In total, how

292
1 hour
long did these
awakenings last? 10 min.
6. What time was 6:35 a.m.
your final
awakening?

Figure 1 (continued)—Sleep Diary Instructions: Core

7. What time did 7:20 a.m.
you get out of bed
for the day?
8. How would you □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
rate the quality of  Poor □ Poor □ Poor □ Poor □ Poor □ Poor □ Poor □ Poor
your sleep? □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair

SLEEP, Vol. 35, No. 2, 2012

□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
9. Comments
(if applicable)
I have a cold
 Sleep Diary Instructions (CSD-M)

General Instructions

What is a Sleep Diary? A sleep diary is designed to gather information about your daily sleep pattern.

How often and when do I fill out the sleep diary? It is necessary for you to complete your sleep diary
every day. If possible, the sleep diary should be completed within one hour of getting out of bed in the
morning.

What should I do if I miss a day? If you forget to fill in the diary or are unable to finish it, leave the
diary blank for that day.

What if something unusual affects my sleep or how I feel in the daytime? If your sleep or daytime
functioning is affected by some unusual event (such as an illness, or an emergency) you may make
brief notes on your diary.

What do the words “bed” and “day” mean on the diary? This diary can be used for people who are
awake or asleep at unusual times. In the sleep diary, the word “day” is the time when you choose or
are required to be awake. The term “bed” means the place where you usually sleep.

Will answering these questions about my sleep keep me awake? This is not usually a problem.
You should not worry about giving exact times, and you should not watch the clock. Just give your best
estimate.

Sleep Diary Item Instructions

Use the guide below to clarify what is being asked for each item of the Sleep Diary.
Date.: Write the date of the morning you are filling out the diary.
1. What time did you get into bed? Write the time that you got into bed. This may not be the time you
began “trying” to fall asleep.
2. What time did you try to go to sleep? Record the time that you began “trying” to fall asleep.
3. How long did it take you to fall asleep? Beginning at the time you wrote in question 2, how long did it
take you to fall asleep.
4. How many times did you wake up, not counting your final awakening? How many times did you wake
up between the time you first fell asleep and your final awakening?
5. In total, how long did these awakenings last? What was the total time you were awake between the
time you first fell asleep and your final awakening. For example, if you woke 3 times for 20 minutes, 35
minutes, and 15 minutes, add them all up (20+35+15= 70 min or 1 hr and 10 min).
6a. What time was your final awakening? Record the last time you woke up in the morning.
6b. After your final awakening, how long did you spend in bed trying to sleep? After the last time you woke-up
(Item #6a), how many minutes did you spend in bed trying to sleep? For example, if you woke up at 8 am but
continued to try and sleep until 9 am, record 1 hour.
6c. Did you wake up earlier than you planned? If you woke up or were awakened earlier than you
planned, check yes. If you woke up at your planned time, check no.
6d. If yes, how much earlier? If you answered “yes” to question 6c, write the number of minutes you
woke up earlier than you had planned on waking up. For example, if you woke up 15 minutes before

Figure 2 continues on the following page

Figure 2—Sleep Diary Instructions (CSD-M)

SLEEP, Vol. 35, No. 2, 2012 293 Consensus Sleep Diary—Carney et al

 the alarm went off, record 15 minutes here.
7. What time did you get out of bed for the day? What time did you get out of bed with no further
attempt at sleeping? This may be different from your final awakening time (e.g. you may have woken
up at 6:35 a.m. but did not get out of bed to start your day until 7:20 a.m.)
8. In total, how long did you sleep? This should just be your best estimate, based on when you went to
bed and woke up, how long it took you to fall asleep, and how long you were awake. You do not need
to calculate this by adding and subtracting; just give your best estimate.
9. How would you rate the quality of your sleep? “Sleep Quality” is your sense of whether your sleep
was good or poor.
10. How restful or refreshed did you feel when you woke up for the day? This refers to how you felt
after you were done sleeping for the night, during the first few minutes that you were awake.
11a. How many times did you nap or doze? A nap is a time you decided to sleep during the day,
whether in bed or not in bed. “Dozing” is a time you may have nodded off for a few minutes, without
meaning to, such as while watching TV. Count all the times you napped or dozed at any time from
when you first got out of bed in the morning until you got into bed again at night.
11b. In total, how long did you nap or doze? Estimate the total amount of time you spent napping or
dozing, in hours and minutes. For instance, if you napped twice, once for 30 minutes and once for 60
minutes, and dozed for 10 minutes, you would answer “1 hour 40 minutes.” If you did not nap or doze,
write “N/A” (not applicable).
12a. How many drinks containing alcohol did you have? Enter the number of alcoholic drinks you had
where 1 drink is defined as one 12 oz beer (can), 5 oz wine, or 1.5 oz liquor (one shot).
12b. What time was your last drink? If you had an alcoholic drink yesterday, enter the time of day in
hours and minutes of your last drink. If you did not have a drink, write “N/A” (not applicable).
13a. How many caffeinated drinks (coffee, tea, soda, energy drinks) did you have? Enter the number of
caffeinated drinks (coffee, tea, soda, energy drinks) you had where for coffee and tea, one drink = 6-8
oz; while for caffeinated soda one drink = 12 oz.
13b. What time was your last caffeinated drink? If you had a caffeinated drink, enter the time of day in
hours and minutes of your last drink. If you did not have a caffeinated drink, write “N/A” (not
applicable).
14. Did you take any over-the-counter or prescription medication(s) to help you sleep? If so, list
medication(s), dose, and time taken: List the medication name, how much and when you took EACH
different medication you took tonight to help you sleep. Include medication available over the counter,
prescription medications, and herbals (example: "Sleepwell 50 mg 11 pm"). If every night is the same,
write “same” after the first day
15. Comments: If you have anything that you would like to say that is relevant to your sleep feel free to
write it here.

Figure 2 (continued)—Sleep Diary Instructions (CSD-M) Figure 2 continues on the following page

range 5-24), with a mean lexile Measure of 702 (SD 341, range
30-1440), corresponding to a mean fourth-grade reading level
(range less than first grade to post-high school).
DISCUSSION
A consensus sleep diary, based on input from a large
group of insomnia experts and on focus groups of individu-
als with and without sleep disorders, was developed. Sleep
diaries have been universally used as the preferred method
for collecting data over time on self-reported sleep and re-
lated function in insomnia research.1,9,10 However, the lack
of standardization in diaries currently used in insomnia re-
SLEEP, Vol. 35, No. 2, 2012
search studies has posed a significant impediment to progress
in the field.1 The development of a Consensus Sleep Diary
addressed this concern.
Advantages of the CSD in particular include the use of
both expert consensus and qualitative patient input, as recom-
mended for development of reliable and valid patient-report
instruments.20 This methodology included collecting and incor-
porating diaries currently in use in the field, consensus group
editing and composing of items, employing focus groups to so-
licit input of subjects/patients both for diary development and
for editing, solicitation of feedback from experts in the insom-
nia research community, and carrying out lexile analysis.
294 Consensus Sleep Diary—Carney et al
 Consensus Sleep Diary—Carney et al
Figure 2 continues on the following page
Consensus Sleep Diary-M (Please Complete Upon Awakening) ID/NAME: ______________________
Sample
Today’s Date 4/5/11
1. What time did you get
10:15 p.m.
into bed?
2. What time did you try
11:30 p.m.
to go to sleep?
3. How long did it take
55 min.
you to fall asleep?
4. How many times did
you wake up, not
6 times
counting your final
awakening?
5. In total, how long did 2 hours
these awakenings last? 5 min.
6a. What time was your
6:35 a.m.
final awakening?
6b. After your final
awakening, how long did 45 min.
you spend in bed trying
to sleep?

295
6c. Did you wake up
earlier than you  Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
planned?
6d. If yes, how much
1 hour
earlier?
7. What time did you get
7:20 a.m.
out of bed for the day?
8. In total, how long did

Figure 2 (continued)—Sleep Diary Instructions (CSD-M)

4 hours 10 min.
you sleep?
9. How would you rate □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
the quality of your sleep?  Poor □ Poor □ Poor □ Poor □ Poor □ Poor □ Poor □ Poor
□ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair
□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
10. How rested or □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all
refreshed did you feel rested rested rested rested rested rested rested rested

SLEEP, Vol. 35, No. 2, 2012

when you woke-up for  Slightly □ Slightly □ Slightly □ Slightly □ Slightly □ Slightly □ Slightly □ Slightly
the day? rested rested rested rested rested rested rested rested
□ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat
rested rested rested rested rested rested rested rested
□ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested
□ Very well- □ Very well- □ Very well- □ Very well- □ Very well- □ Very well- □ Very well- □ Very well-
rested rested rested rested rested rested rested rested
 Consensus Sleep Diary—Carney et al
Consensus Sleep Diary-M Continued ID/NAME: _______________________
Sample
Today’s Date 4/5/11
11a. How many
times did you nap or
2 times
doze?
11b. In total, how 1 hour
long did you nap or 10 min.
doze?
12a. How many
drinks containing 3 drinks
alcohol did you
have?
12b. What time was 9 :20 p.m.
your last drink?
13a. How many
caffeinated drinks
(coffee, tea, soda, 2 drinks

296
energy drinks) did
you have?
13b. What time was
3 :00 p.m.
your last drink?
14. Did you take any
over-the-counter or  Yes □ No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No
prescription Medication(s): Medication(s): Medication(s): Medication(s): Medication(s): Medication(s): Medication(s): Medication(s):

Figure 2 (continued)—Sleep Diary Instructions (CSD-M)

medication(s) to help
you sleep? Relaxo-Herb
Dose: Dose: Dose: Dose: Dose: Dose: Dose: Dose:
If so, list
50 mg
medication(s), dose,
and time taken Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken:
11 pm

SLEEP, Vol. 35, No. 2, 2012

15. Comments
(if applicable)
I have a cold
 Sleep Diary Instructions (CSD-E)

General Instructions

What is a Sleep Diary? A sleep diary is designed to gather information about your daily sleep pattern.

How often and when do I fill out the sleep diary? It is necessary for you to complete your sleep diary every
day. If possible, the sleep diary should be completed within one hour of getting out of bed in the morning. The
Nighttime Sleep Diary questions can be completed before you go to bed at night.

What should I do if I miss a day? If you forget to fill in the diary or are unable to finish it, leave the diary blank
for that day.

What if something unusual affects my sleep or how I feel in the daytime? If your sleep or daytime
functioning is affected by some unusual event (such as an illness, or an emergency) you may make brief notes
on your diary.

What do the words “bed” and “day” mean on the diary? This diary can be used for people who are awake or
asleep at unusual times. In the sleep diary, the word “day” is the time when you choose or are required to be
awake. The term “bed” means the place where you usually sleep.

Will answering these questions about my sleep keep me awake? This is not usually a problem. You should
not worry about giving exact times, and you should not watch the clock. Just give your best estimate.

Morning Sleep Diary Item Instructions

Use the guide below to clarify what is being asked for each item of the Sleep Diary.
Date: Write the date of the morning you are filling out the diary.
1. What time did you get into bed? Write the time that you got into bed. This may not be the time you
began “trying” to fall asleep.
2. What time did you try to go to sleep? Record the time that you began “trying” to fall asleep.
3. How long did it take you to fall asleep? Beginning at the time you wrote in question 2, how long did it
take you to fall asleep.
4. How many times did you wake up, not counting your final awakening? How many times did you wake up
between the time you first fell asleep and your final awakening?
5. In total, how long did these awakenings last? What was the total time you were awake between the
time you first fell asleep and your final awakening. For example, if you woke 3 times for 20 minutes, 35
minutes, and 15 minutes, add them all up (20+35+15= 70 min or 1 hr and 10 min).
6a. What time was your final awakening? Record the last time you woke up in the morning.
6b. After your final awakening, how long did you spend in bed trying to sleep? After the last time you woke-up
(Item #6a), how many minutes did you spend in bed trying to sleep? For example, if you woke up at 8 am but
continued to try and sleep until 9 am, record 1 hour.
6c. Did you wake up earlier than you planned? If you woke up or were awakened earlier than you planned,
check yes. If you woke up at your planned time, check no.
6d. If yes, how much earlier? If you answered “yes” to question 6c, write the number of minutes you woke
up earlier than you had planned on waking up. For example, if you woke up 15 minutes before the alarm
went off, record 15 minutes here.
Figure 3 continues on the following page

Figure 3—Sleep Diary Instructions (CSD-E)

SLEEP, Vol. 35, No. 2, 2012 297 Consensus Sleep Diary—Carney et al

 7. What time did you get out of bed for the day? What time did you get out of bed with no further
attempt at sleeping? This may be different from your final awakening time (e.g. you may have woken up
at 6:35 a.m. but did not get out of bed to start your day until 7:20 a.m.)
8. In total, how long did you sleep? This should just be your best estimate, based on when you went to
bed and woke up, how long it took you to fall asleep, and how long you were awake. You do not need
to calculate this by adding and subtracting; just give your best estimate.
9. How would you rate the quality of your sleep? “Sleep Quality” is your sense of whether your sleep
was good or poor.
10. How restful or refreshed did you feel when you woke up for the day? This refers to how you felt after
you were done sleeping for the night, during the first few minutes that you were awake.

Nighttime Sleep Diary Item Instructions

Please complete the following items before you go to bed.
Date: Write the date of the evening you are filling out the diary.
11a. How many times did you nap or doze? A nap is a time you decided to sleep during the day,
whether in bed or not in bed. “Dozing” is a time you may have nodded off for a few minutes, without
meaning to, such as while watching TV. Count all the times you napped or dozed at any time from
when you first got out of bed in the morning until you got into bed again at night.
11b. In total, how long did you nap or doze? Estimate the total amount of time you spent napping or
dozing, in hours and minutes. For instance, if you napped twice, once for 30 minutes and once for 60
minutes, and dozed for 10 minutes, you would answer “1 hour 40 minutes.” If you did not nap or doze,
write “N/A” (not applicable).
12a. How many drinks containing alcohol did you have? Enter the number of alcoholic drinks you had
where 1 drink is defined as one 12 oz beer (can), 5 oz wine, or 1.5 oz liquor (one shot).
12b. What time was your last drink? If you had an alcoholic drink yesterday, enter the time of day in
hours and minutes of your last drink. If you did not have a drink, write “N/A” (not applicable).
13a. How many caffeinated drinks (coffee, tea, soda, energy drinks) did you have? Enter the number
of caffeinated drinks (coffee, tea, soda, energy drinks) you had where for coffee and tea, one drink =
6-8 oz; while for caffeinated soda one drink = 12 oz.
13b. What time was your last drink? If you had a caffeinated drink, enter the time of day in hours and
minutes of your last drink. If you did not have a caffeinated drink, write “N/A” (not applicable).
14. Did you take any over-the-counter or prescription medication(s) to help you sleep? If so, list
medication(s), dose, and time taken: List the medication name, how much and when you took EACH
different medication you took tonight to help you sleep. Include medication available over the counter,
prescription medications, and herbals (example: "Sleepwell 50 mg 11 pm"). If every night is the same,
write “same” after the first day
15. Comments If you have anything that you would like to say that is relevant to your sleep feel free to
write it here.

Figure 3 (continued)—Sleep Diary Instructions (CSD-E) Figure 3 continues on the following page

The process of developing the CSD also provided new infor-
mation about sleep diaries and about how people conceptual-
ize their sleep. Among the leading insomnia experts in the field
consulted, 16 unique sleep diaries were being used and these
varied in terms of the items included, in the item formats used
and in their layout. After considering these and other possibili-
ties it was possible to reach consensus on core diary items, their
format, and layout as manifested in the final version of the CSD.
SLEEP, Vol. 35, No. 2, 2012
Beyond the consensus core items, a variety of optional items
were proposed, reflecting the varying aims and constraints of
research studies, the different contexts in which the diary was
anticipated to see application, and the specific preferences of
individual investigators. Further, subjects/patients were in
agreement on the quantitative dimensions of their sleep that
they considered to be important, and this was reflected in the
items included in the final CSD. However, participants/patients
298 Consensus Sleep Diary—Carney et al
 Consensus Sleep Diary—Carney et al
Figure 3 continues on the following page
Consensus Sleep Diary - E (Please Complete Upon Awakening) ID/NAME: ____________________________
Sample
Today’s Date 4/5/11
1. What time did you get
10:15 p.m.
into bed?
2. What time did you try
11:30 p.m.
to go to sleep?
3. How long did it take
55 min.
you to fall asleep?
4. How many times did
you wake up, not
6 times
counting your final
awakening?
5. In total, how long did 2 hours
these awakenings last? 5 min.
6a. What time was your
6:35 a.m.
final awakening?
6b. After your final
awakening, how long did 45 min.
you spend in bed trying
to sleep?

299
6c. Did you wake up
earlier than you  Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
planned?
6d. If yes, how much
1 hour
earlier?
7. What time did you get
7:20 a.m.
out of bed for the day?
8. In total, how long did

Figure 3 (continued)—Sleep Diary Instructions (CSD-E)

4 hours 10 min.
you sleep?
9. How would you rate □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
the quality of your sleep?  Poor □ Poor □ Poor □ Poor □ Poor □ Poor □ Poor □ Poor
□ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair
□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
10. How rested or □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all □ Not at all
refreshed did you feel rested rested rested rested rested rested rested rested

SLEEP, Vol. 35, No. 2, 2012

when you woke-up for  Slightly □ Slightly □ Slightly □ Slightly □ Slightly □ Slightly □ Slightly □ Slightly
the day? rested rested rested rested rested rested rested rested
□ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat □ Somewhat
rested rested rested rested rested rested rested rested
□ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested □ Well-rested
□ Very well- □ Very well- □ Very well- □ Very well- □ Very well- □ Very well- □ Very well- □ Very well-
rested rested rested rested rested rested rested rested
 Consensus Sleep Diary—Carney et al
Consensus Sleep Diary - E (Please Complete Before Bed) ID/NAME: _________________________
Sample
Today’s Date 4/4/11
11a. How many
times did you nap or
2 times
doze?
11b. In total, how 1 hour
long did you nap or 10 min.
doze?
12a. How many
drinks containing 3 drinks
alcohol did you
have?
12b. What time was 9 :20 p.m.
your last drink?
13a. How many
caffeinated drinks
(coffee, tea, soda, 2 drinks

300
energy drinks) did
you have?
13b. What time was
3 :00 p.m.
your last drink?
14. Did you take any
over-the-counter or  Yes □ No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No □Yes □No
prescription Medication(s): Medication(s): Medication(s): Medication(s): Medication(s): Medication(s): Medication(s): Medication(s):

Figure 3 (continued)—Sleep Diary Instructions (CSD-E)

medication(s) to help
you sleep? Relaxo-Herb
Dose: Dose: Dose: Dose: Dose: Dose: Dose: Dose:
If so, list
50 mg
medication(s), dose,
and time taken Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken: Time(s) taken:
11 pm

SLEEP, Vol. 35, No. 2, 2012

15. Comments
(if applicable)
I have a cold
also felt that the diary format limited their ability to adequately
convey the entirety of their sleep experience, and they advocat-
ed for additional means to describe these experiences. Thus, the
CSD and other diaries should be seen as providing information
about some, but not all, patient-relevant aspects of sleep. This
theme could be seen as a commentary on interactions regarding
sleep with health care providers in general, beyond what a sleep
diary is able to capture. Sleep diaries must be augmented with
other tools such as other patient-reported outcome instruments
and clinical tools where a broader assessment of sleep is need-
ed. The focus group data also suggested that many individuals
prefer alternative formats for sleep data representation (clock
faces, time lines). Although the consensus of the group dictated
against employing these formats in the core diary, such alterna-
tive formats could be considered for specific applications.
In summary, focus group participants clearly indicated
agreement between the quantitative dimensions of sleep they
considered to be important and those included in the diary.
However, participants also advocated for a more nuanced and
experiential description of sleep. In clinical and research set-
tings, these more qualitative aspects of sleep and wakefulness
may be captured by other more efficient methods such as spe-
cific patient-reported outcomes or clinical interviews. Finally,
multiple participants advocated a more “visual” approach to
quantification of sleep (clock faces, time lines) and requested
simpler formats. Developing alternate methods for administra-
tion of the CSD (e.g., electronic versions, single-day formats)
may be useful to match the preferences of specific respondents.
The CSD presented in this document represents a critical
first step in the process of standardizing a sleep diary for use
across a wide-range of research and clinical applications. It is
important that additional work investigate the reliability and
validity of this instrument. There are some inherent challenges
in establishing reliability and validity with conventional psy-
chometric analyses. For example, one way of assessing reliabil-
ity is to carry out diary assessments in the same individuals at
two or more time points; this establishes test-retest reliability.
However, because sleep is known to be highly variable across
nights, it may violate the constancy (i.e., temporal stability) as-
sumption of test-retest reliability.21 A valid assessment of test-
retest reliability for a sleep diary would likely require many
nights to overcome the problem of instability in sleep itself.22
Other reliability indices assess the internal consistency of the
measure; however, the sleep diary is not intended to measure
one construct, and items are not expected to correlate with one
another (e.g., there is no reason to expect that bed time would
correlate with number of awakenings). One possibility is to fo-
cus on the validity of the diary. Construct validity was explored
in the current project via user/focus group feedback and expert
feedback (both within and outside the Consensus workgroup).
It would be helpful to have more exploration of the construct
validity of the CSD. For example, future studies could compare
the diary data across groups in which the diagnosis has been es-
tablished according to clinical diagnostic criteria (e.g., healthy
controls, insomnia patients, other groups of interest). One could
also establish the convergent validity of the CSD by compar-
ing CSD data with data derived from other means of assessing
sleep such as polysomnography (PSG), actigraphy, and other
self-report instruments. However, the prospective subjective
SLEEP, Vol. 35, No. 2, 2012
perception of sleep in a sleep diary is a unique and valued per-
spective, and thus, might not necessarily be expected to agree
with objective measures (e.g., PSG, actigraphy). Despite the
fact that sleep diaries are widely used in clinical and research
settings, with few exceptions,23 almost no formal reliability and
validity data have been presented. One of the reasons for the
paucity of data may relate to the unique challenges mentioned
above. Although the CSD is unique in that it is the first diary to
be developed with rigorous methodology for patient-reported
outcome development, devising creative ways to evaluate the
reliability and validity appropriately will be an important next
step towards the goal of standardizing sleep diary assessment in
insomnia research and practice.
ACKNOWLEDGMENTS
The authors acknowledge the participation of the members
of the original Pittsburgh Assessment Conference in this proj-
ect: Drs. Celyne Bastien, Ruth Benca, Michael Bonnet, Rich-
ard Bootzin, Christopher Drake, Colin Espie, Leah Friedman,
Goran Hajak, Allison Harvey, Peter Hauri, Kevin Morgan,
Michael Perlis, Dieter Riemann, Arthur Spielman, Edward
Stepanski, Alexandros Vgontzas, James Walsh, and William
Wohlgemuth. The authors also thank Melissa Shableski-Cade
for her invaluable work in coordinating this project and format-
ting the diaries; the members of the PROMIS research team at
the University of Pittsburgh for conducting the focus groups;
and Dr. Kelly E. McShane, Ryerson University for her expertise
in extracting qualitative themes from the focus group data.
Additional support from MH24652, AG00972, and AG26177
(DJB); AG08415, CA112035, UL1RR031980, the UCSD Stein
Institute for Research on Aging and the Department of Veter-
ans Affairs Center of Excellence for Stress and Mental Health
(CESAMH) (SAI); MH67057, HL-073259 and Department of
Veterans Affairs IIR-00-091 (JDE); AG14738 and DA13574
(KLL); and MH60413 and Canadian Institutes of Health Re-
search MT42504 (CMM).
DISCLOSURE STATEMENT
The 2005 Pittsburgh conference and manuscript preparation
were supported by an educational grant from the National Insti-
tute of Mental Health; by unrestricted educational grants from
Pfizer, Inc; Sanofi-Aventis, Sepracor, Inc; Takeda Pharmaceu-
ticals; and by The Mental Health Intervention Research Center
at the University of Pittsburgh (MH30915). Industry sponsors
did not contribute to CSD conference planning, nor did they
participate in any aspect of manuscript preparation. Dr. Carney
has no conflicts of interest to report. Dr. Buysse has served as a
consultant (for less than $10,000 in fees) for the following com-
panies: Actelion, Cephalon, Eisai, Eli Lilly, GlaxoSmithKline,
Merck, Neurocrine, Neurogen, Pfizer, Philips, Purdue Pharma,
L.P., Sanofi-Aventis, Sepracor/Sunovion, Somnus Therapeu-
tics, Takeda, and Transcept Pharmaceuticals Inc. Dr. Buysse
has helped produce CME materials and lectures indirectly sup-
ported by Sanofi-Aventis, Sepracor/Sunovion and Takeda, and
has been paid for lectures at non-CME educational meetings by
Servier. Dr. Ancoli-Israel has served on the following Consul-
tant/Scientific Advisory Boards (for less than $10,000 in fees):
Ferring Pharmaceuticals Inc., GlaxoSmithKline, Johnson &
Johnson, Merck, NeuroVigil, Inc., Pfizer, Philips, Purdue Phar-
301 Consensus Sleep Diary—Carney et al
ma LP, Sanofi-Aventis, and Somaxon. Dr. Edinger has research
support from Philips/Respironics and has consulted with Live
to Sleep, Inc. (for less than $10,000 in fees). Dr. Krystal has
received grants/research support from: Sanofi-Aventis, Cepha-
lon, GlaxoSmithKline, Merck, Neurocrine, Pfizer, Sepracor/
Sunovion, Somaxon, Takeda, Transcept, Respironics, Neuro-
gen, Evotec, Astellas, Abbott; and has served as a consultant
for: Abbott, Actelion, Arena, Astellas, Axiom, AstraZeneca,
BMS, Cephalon, Eli Lilly, GlaxoSmithKline, Jazz, Johnson
and Johnson, King, Merck, Neurocrine, Neurogen, Novartis,
Organon, Ortho-McNeil- Janssen, Pfizer, Respironics, Roche,
Sanofi-Aventis, Sepracor, Somaxon, Takeda, Transcept, Astel-
las, Kingsdown Inc. Dr. Lichstein has served on an advisory
board for Merck and has received research support from Take-
da. Dr. Morin has received research support from: Merck and
Sanofi-Aventis, and has served a consulting/advisory role for
Merck, Sanofi-Aventis, and Eli-Lilly.
REFERENCES
1. Buysse DJ, Ancoli-Israel S, Edinger J D, Lichstein KL, Morin CM. Rec-
ommendations for a standard research assessment of insomnia. Sleep
2006;29:1155-73.
2. Daley M, Morin CM, LeBlanc M, Gregoire JP, Savard J. The economic
burden of insomnia: Direct and indirect costs for individuals with insomnia
syndrome, insomnia symptoms, and good sleepers. Sleep 2009;32:55-64.
3. Kyle SD, Morgan K, et al. Insomnia and health-related quality of life.
Sleep Med Rev 2010;14:69-82.
4. Morin CM. Measuring outcomes in randomized clinical trials of insomnia
treatments. Sleep Med Rev 2003;7:263-79.
5. Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behav-
ioral interventions for insomnia and their efficacy in middle-aged adults
and in older adults 55+ years of age. Health Psychol 2006;25:3-14.
6. Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions
for insomnia: A meta-analysis of treatment efficacy. Am J Psychiatry
1994;151:1172-80.
7. Murtagh DR, Greenwood KM. Identifying effective psychologi-
cal treatments for insomnia: A meta-analysis. J Consult Clin Psychol
1995;63:79-89.
SLEEP, Vol. 35, No. 2, 2012
8. Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of phar-
macotherapy and behavior therapy for persistent insomnia. Am J Psychia-
try 2002;159:5-11.
9. Bootzin RR, Nicassio PM. Behavioral treatments for insomnia. In: Hers-
en M, Eissler R, Miller P, eds. Progress in behavior modification. Vol 6.
New York: Academic Press; 1978:1-45.
10. Bootzin RR, Engle-Friedman M. The assessment of insomnia. Behav As-
sess 1981;3:107-26.
11. U S Department of Health and Human Services. Guidance for industry:
patient-reported outcome measures: use in medical product development
to support labeling claims, 2009.
12. Revicki DA, Erickson PA, Sloan JA, et al. Interpreting and reporting re-
sults based on patient-reported outcomes. Value Health 2007;10:S116-24.
13. Krueger RA. Focus groups: a practical guide for applied research. Thou-
sand Oaks, CA: SAGE; 1994.
14. Schwarz N, Sudman N. Answering questions: Methodology for determin-
ing cognitive and communicative processes in survey research. San Fran-
cisco, CA: Jossey-Bass; 1996.
15. Kelly MAR, Morse JQ, Stover A, et al. Describing depression: Congru-
ence between patient experiences and clinical assessments. Br J Clin Psy-
chol 2011;50:46-66.
16. Silverman D. Qualitative research: theory, method, and practice. Second
ed. Thousand Oaks, CA: Sage Publications; 2004.
17. Stewart DW, Shamdasani PN, Rook DW. Focus groups: theory and prac-
tice. 2nd ed. Thousand Oaks, CA: Sage; 2007.
18. Stenner AJ, Smith M. Testing construct theories. Percept Mot Skills 1982;
55:415-26.
19. Stenner B, Holusm I, Smith DR, Smith M. The Lexile framework. Dur-
ham, NC: MetaMetrics; 1988.
20. Edinger JD, Olsen MK, Stechuchak KM, et al. Reliability and validity of
the Duke Structured Interview for Sleep Disorders for Insomnia Screen-
ing. Sleep 2009;32:A265.
21. Pedhazur EJ, Schmelkin LP. Measurement, design, and analysis: an in-
tegrated approach. Hillsdale, NJ: Lawrence Erlbaum Associates, 1991.
22. Wohlgemuth WK, Edinger JD, Fins AI, Sullivan RJ. How many nights
are enough? The short-term stability of sleep parameters in elderly insom-
niacs and normal sleepers. Psychophysiology 1999;36:233-44.
23. Monk TH, Reynolds CF, Kupfer DJ, et al. The Pittsburgh Sleep Diary. J
Sleep Res 1994;3:111-20.
302 Consensus Sleep Diary—Carney et al